MEDICARE: ANTEKA RX INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy	027796	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3351234	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285748269
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANTEKA RX INC

Provider Business Mailing Address
First Line	:	511 BRIGHTON BEACH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235
Country	:	US
Telephone Number	:	718-332-4002
Fax Number	:	718-676-1871

Provider Business Practice Location Address
First Line	:	511 BRIGHTON BEACH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-6403
Country	:	US
Telephone Number	:	718-332-4002
Fax Number	:	718-676-1871

Authorized Official
Title or Position	:	OWER
Name	:	MRS. CHILA ALSAYGH
Credential	:	HIGH SHCOOL
Telephone Number	:	917-559-3505

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	11/14/2010

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